| BIOGRAPHY

Tran Bao Thien currently serves as the Country Manager of Perfios in Vietnam – a global technology platform in the financial sector, serving over 500 leading banking and insurance organizations across 19 countries.
With more than 10 years of experience in digital transformation, AI, fintech, and insurance, Mr. Thiên has played a key role in consulting and implementing AI-driven solutions for many of the top insurance companies in Vietnam and the region.
He joined Perfios with a mission to listen, collaborate, and accelerate comprehensive digital transformation in the insurance industry – especially in areas such as customer experience, claims adjudication, fraud, waste and abuse (FWA) detection, and new business underwriting automation. Under his leadership, Perfios has achieved significant progress in Vietnam, forming strategic partnerships with pioneering insurers in the market.
Prior to joining Perfios, Mr. Thiên held several key positions at major technology and strategic consulting firms, where he developed strong expertise in bridging technology with the operational and business needs of the financial and insurance sectors in Vietnam.

| TOPIC

AI-powered Health Claims Adjudication – The CEO’s Definitive Guide

| ABSTRACT

Perfios Acclaim is an AI and ML-driven platform designed to automate the end-to-end health insurance claims process. It performs intelligent data extraction, multi-layered categorization using three distinct AI/ML models, dynamic benefit mapping, and auto-adjudication. The categorization engine is continuously enhanced with up-to-date medical and health knowledge from leading global partners, ensuring accuracy and relevance. Acclaim’s FWA (Fraud, Waste, Abuse) detection engine identifies suspicious claims in real-time, improving financial control. The platform supports both STP and non-STP workflows, adapting seamlessly to diverse operational needs. It also applies machine learning to improve accuracy over time, based on live feedback and outcomes. In a recent case study, Acclaim helped improve claims processing productivity by 70% and reduced reimbursement losses by 3% through enhanced Non-Covered Item (NCI) detection and FWA triggers. Scalable, configurable, and compliant with local regulations, Acclaim empowers insurers to drive digital transformation while enhancing customer experience and operational performance.